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College  of  l^\)p&imn&  anb  ^urgeong 


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The  ]\Ialariajl  rvIosQuixo  (Female)  ix  Stinging  Position. 

The  mosquito  acts  as  an  intermediar}^  host,  carrying  the  infection  in  the 
flmds  of  its  body,  and  introducing  it  into  the  blood  of  the  hiunan  subject 
through  wounds  made  by  its  bite.  (From  the  model  at  the  American  Museum 
of  Natural  History,  Xew  York.) 


THE  TRIUMPH 


AMERICAN  MEDICINE 


Construction  of  the  Panama  Canal 


BY 

J.  EWING  HEARS,  M.D.,  LL.D. 


PHILADELPHIA 

PUBLISHED  BY  WM.  J.  DORNAN 

701-709  Arch  Street 

1911 


WITH  GRATEFUL  APPRECIATION  THIS   LITTLE  BOOK  IS   DEDICATED 
TO   THE  LADY   OF  THE   OPEN   ARMS   INN 


Ich  komme  vom  Gebirge  her, 

Es  dampft  das  Thai,  es  braust  das  Meer- 

Ich  wandre  still,  bin  wenig  froh, 

Und  immer  fragt  die  Fremde  wo. 


INTRODUCTION 


In  his  great  work — the  reclamation  of  the  pestilence  breeding  neck  of 
land  which  binds  together  the  two  portions  of  our  Continent — Colonel 
W.  C.  Gorgas,  U.  S.  A.,  Chief  Sanitary  Officer,  Isthmian  Canal  Com- 
mission, has  contributed  another  and  a  most  important  chapter  to  the 
growing  volume  of  sanitary  science.  He  has  demonstrated  beyond 
question  the  efficiency  of  an  organized  system  of  sanitation,  in  a  field 
presenting  all  of  the  difficulties  and  all  of  the  destructive  influences 
which  characterize  territorial  areas  in  the  tropics.  He  has  shown 
that,  despite  the  normal  conditions  of  perverted  states  of  health,  the 
offspring  of  soil  and  climatic  conditions,  these  lands  of  our  globe  may 
be  so  purged  of  disease  and  purified  by  systems  of  sanitation  that  they 
will  assume  in  all  respects  the  states  of  health  belonging  to  a  temperate 
cKme.  His  work  marks  an  epoch  in  the  progress  of  the  world,  and 
teaches  a  lesson  that  "he  who  rims  may  read."  It  inculcates  in  force- 
ful manner  the  important  place  instruction  in  sanitary  science  should 
have  in  all  institutions  devoted  to  the  education  of  the  growing 
race,  beginning  in  elementary  form  in  the  schools  of  the  young  and 
carried  to  the  most  advanced  degree  in  our  colleges,  so  that  the  simple 
yet  great  principles  of  hygiene  should  be  a  part  of  the  knowledge  of 
every  citizen  whose  civic  obHgations  and  duties  make  him  a  factor 
in  the  prevention  of  disease  and  in  the  conservation  of  the  public 
health. 


THE  TRIUMPH  OF  AMERICAN  MEDICINE  IN  THE 
CONSTRUCTION  OF  THE  PANAMA  CANAL 


In  a  paper  published  in  the  volume  of  Transactions  of  the 
American  Surgical  Association  for  1908,  entitled  "Modern 
Medicine  and  Surgery  in  the  Orient,"  I  discussed  the  subject  of 
the  conservation  of  the  pubhc  health,  and  directed  attention  to  the 
methods  of  sanitation  practised  in  the  countries  of  the  Orient,  as 
I  had  observed  them  in  a  Adsit  which  I  had  recently  made  to  these 
coimtries.  In  concluding  the  paper,  I  spoke  of  what  had  been 
accompHshed  in  our  country,  and  referred  to  the  great  work  done 
in  the  Isthmian  Canal  Zone  by  Col.  W.  C.  Gorgas,  U.  S.  A.,  Chief 
Sanitary  Officer,  Isthmian  Canal  Commission,  and  stated  that  his 
achievements  had  made  the  construction  of  the  Canal  possible, 
claiming  that  its  completion  would  be  a  triumph  of  American 
Medicine. 

During  the  past  winter  I  visited  the  Canal  Zone  and  had, 
through  the  courtesy  of  Col.  Gorgas,  an  opportunity  to  observe 
the  marvellous  results  obtained  in  the  conservation  of  the  health, 
by  the  methods  of  sanitation  employed,  of  the  large  army  of 
officials  and  work  people,  some  47,000  in  number,  engaged  in 
the  stupendous  undertaking  of  the  Canal  construction. 

In  order  to  fully  appreciate  what  has  been  accompushed  by  the 
system  of  sanitation  inaugurated  by  Col.  Gorgas  and  so  perfectly 


8  MEARS:  THE  TRIUMPH  OF  AMERICAN  MEDICINE 

conducted  by  him  and  his  able  corps  of  assistants,  it  is  necessary  to 
consider  the  conditions  of  health  which,  up  to  the  beginning  of  the 
work  of  the  Americans,  prevailed  in  the  cities  of  Colon  and  Panama, 
and  in  what  is  now  known  as  the  Canal  Zone,  ten  miles  of  terri- 
tory acquired  by  purchase  by  the  United  States  Government 
from  the  Republic  of  Panama,  and  which  is  located  five  miles 
on  either  side  of  the  Canal  route,  including  an  area  of  three 
hundred  and  twenty-two  square  miles. 

For  nearly  four  hundred  years  that  portion  of  the  neck  of  land 
between  the  Continents  of  North  and  South  America,  now  called 
the  Isthmus  of  Panama,  has  been  known  to  be  one  of  the  un- 
healthiest  regions  of  the  Globe.  Uninhabitable  to  any  but  the 
few  natives  who  made  their  homes  there,  and  the  residents  of  the 
cities  of  Panama  and  Chagres,  at  the  mouth  of  the  Chagres  River, 
on  the  Atlantic  Ocean,  with  their  blood  charged  to  the  full  with 
malarial  parasites,  who  fell  in  great  numbers  victims  to  the 
deadly  scourges  of  malarial  and  yellow  fever,  known  in  their 
most  pernicious  forms  as  Chagres  fever,  which,  existing  as 
endemic  forms,  frequently  assumed  the  proportions  of  devas- 
tating epidemics,  developing  under  the  climatic  conditions  which 
encouraged  the  facile  breeding  of  the  anopheles  mosquitoes,  and 
the  absence  of  any  quarantine  regulations  which  controlled  the 
influx  of  the  stegomyia  species,  or  of  its  work  in  transmitting 
infection. 

The  eager  quest  of  gold  in  the  waters  and  lands  of  California 
brought  many  white  people  to  the  Isthmus  in  the  year  1849,  who 
desired  in  this  way  to  avoid  the  longer  and  much  delayed  route 
around  Cape  Horn.  On  foot,  on  mule,  and  in  vehicles  of  varied 
design  they  fought  their  way  through  the  almost  impenetrable 
jungle,  in  torrid  heat,  under  blistering  sun-rays,  and  in  torrential 
rains.  Overcome  by  climatic  conditions  and  exhausted  by  fatigue, 
they  fell  easy  victims  to   the  fierce  onslaught   of   the  native 


MEARS:  THE  TRIUMPH  OF  AMERICAN  MEDICINE  9 

anopheles,  which  in  swarming  myriads  welcomed  the  invasion  of 
new  blood.  Many  laid  down  to  die  to  find  an  uninviting  grave 
in  the  desolate  morass  and  in  the  tangled  jungle. 

The  tide  of  travel  across  the  Isthmus  increased  to  such  extent 
as  to  encourage  the  building  of  a  railroad  from  the  Atlantic  to  the 
Pacific  Ocean.  This  was  undertaken  in  1849  ^^^  completed  in 
1855,  under  very  great  difficulties  in  railway  construction,  owing 
to  the  conditions  of  land  and  soil.  Here  again  the  anopheles  and 
stegomyia  played  havoc  in  the  ranks  of  the  laborers,  and  so  many 
perished  from  disease  that  it  became  a  common  saying  that  every 
raihoad  tie  represented  the  dead  body  of  a  workman. 

Ignorant  of  the  cause  of  malarial  and  yeUow  fevers  and  their 
methods  of  transmission,  the  medical  officers  in  charge  were 
forced  to  content  themselves  simply  in  combating  the  developed 
disease  with  antimalarial  remedies  and  those  commonly  employed 
in  treating  yellow  fever. 

In  the  year  1881  another  invasion  of  the  Isthmus  took  place, 
when  the  original  French  Company  began  the  construction  of  an 
Isthmian  Canal.  Eleven  years — 1881  to  1S92 — ^were  consumed 
in  construction  work  before  the  effort  was  abandoned,  with  very 
little  accomplished  comparatively  in  the  way  of  a  completed  canal. 
While  it  is  stated  that  corrupt  methods  and  graft  played  an 
important  part  in  producing  the  failure,  it  is  believed  that  diseases, 
now  preventable,  were  chiefly  responsible.  The  fifty  buildings 
devoted  to  hospital  purposes  left  by  the  French  bear  testimony  to 
the  fact  that  the  medical  department  was  fully  organized,  but  its 
work  was  largely  ineffective,  because  the  state  of  knowledge  then 
existing  was  defective  in  producing  information  as  to  the  pre- 
vention of  the  diseases  the  medical  officers  were  called  upon  to 
combat. 

That  heroic  son  of  Medicine,  Dr.  Lazear,  U.  S.  A.,  had  not 
given  his  life  to  demonstrate  that  the  infection  of  yellow  fever 


10  MEARS:  THE  TRIUMPH  OF  AMERICAN  MEDICINE 

was  transmitted  by  the  mosquito,  Stegom3da  fasciata,  and  Col. 
Gorgas,  U.  S.  A.  had  not  driven  disease  and  pestilence  out  of 
Havana  by  the  enlightened  methods  of  sanitation  devised  by  him. 
The  hopeless  contest  waged  against  disease  by  the  French  is 
illustrated  in  the  statement  made  by  Capt.  Constant  Cordier, 
U.  S.  A.,  in  the  thesis  presented  by  him  to  the  San  Marcos  Uni- 
versity, Lima,  Peru,  for  the  degree  of  Doctor  of  Philosophy,  to 
the  effect  that  in  five  years  the  French  lost  eleven-sixteenths  of 
the  working  force,  one-third  of  the  number  French  subjects.  Out 
of  the  twenty-four  Sisters  of  Charity  engaged  in  nursing  in  the 
Ancon  Hospital,  twenty  died  of  yellow  fever.  Of  seventeen 
engineers  who  came  on  one  steamer,  sixteen  died.  During  the 
period  of  time  in  which  the  Panama  Railroad  was  undergoing 
construction,  and  in  the  eleven  years  in  which  the  French  were 
engaged  in  their  efforts  to  construct  the  Canal,  the  losses  by 
death  from  malarial  and  yellow  fever  were  as  great  as  any  suffered 
by  the  white  race  in  the  history  of  the  tropics. 

In  the  year  1904,  when  the  United  States  Government  took 
charge  of  the  Canal  Zone  and  began  the  Canal  construction.  Col. 
Gorgas,  fresh  from  the  victories  won  by  him  in  Cuba,  was  assigned 
to  duty  as  the  Chief  Sanitary  Officer  in  the  Zone,  and  began  the 
colossal  work  of  transforming  a  territorial  area  of  three  hundred 
and  twenty-two  square  miles,  surcharged  with  disease-producing 
causes,  into  a  region  so  free  from  disease  that  the  mortality  among 
the  officials  and  working  people  is  now  not  greater  than  that  of 
the  towns  and  cities  of  our  country. 

This  standard  of  health  was  regarded  as  essential,  in  order 
(i)  to  attract  and  to  protect  skilled  white  workmen  who  came  from 
their  homes  in  our  country,  and  (2)  to  maintain  a  condition  of 
health  among  all  classes  of  the  working  force  which  would  con- 
tribute to  the  continuous  and  successful  labor  which  was  necessary 
in  accomplishing  the  Canal  construction.    Col.  Gorgas  was  not 


Old  yellow  fever  ward  at  Ancon  Hospital. 


MEAHS:   THE  TRIUMPH  OF  AMERICAN  MEDICINE  II 

only  charged  with  the  duty  of  converting  the  intricate  recesses  of 
the  jungle  into  healthful  homes  for  the  employees,  but  also  he  was 
confronted  with  the  difficult  task  of  renovating  two  cities,  aggre- 
gating in  population  fifty  thousand  people,  one  of  which  had  been 
for  quite  two  and  a  half  centuries  the  birthplace  and  the  home 
of  pestilence  and  disease.  Such  were  the  conditions  which  existed 
within  the  Canal  Zone  which  demanded  treatment.  At  either  end 
of  the  Zone  were  gates  which,  unless  securely  closed  against  the 
introduction  of  infective  diseases,  would  prove  to  be  fertile  sources 
of  conditions  which  would  render  futile  the  efforts  made  to  estab- 
lish correct  sanitary  methods  within  the  Zone.  These  were  the 
harbors  of  Colon,  on  the  Atlantic  Ocean,  and  Panama,  on  the 
Pacific  Ocean. 

Into  these  harbors  came  the  trade  of  the  World,  in  vessels  from 
the  Eastern  and  Western  Hemispheres.  On  the  Atlantic  side 
the  islands  of  the  Antilles  and  the  many  ports  of  the  eastern  coast 
of  Central  and  South  America  had  free  intercourse  with  the  Zone 
through  the  Colon  harbor.  In  many  of  the  ports  yellow  fever 
existed  in  endemic  form.  History  records  that  for  over  one 
himdred  and  fifty  years  yellow  fever  had  existed  in  Havana,  Cuba, 
as  an  endemic  disease.  On  the  west  coast  of  South  America 
similar  conditions  existed,  many  ports  not  only  giving  residence 
to  the  infective  fevers  but  also  to  the  plague. 

In  Guayaquil,  Ecuador,  it  is  stated  that  the  inhabitants  are 
inclined  to  rejoice  in  the  presence  of  yellow  fever,  as  this  con- 
dition of  health  keeps  out  the  foreigners  who  would  invade  the 
country  and  rob  them  of  their  business  opportunities. 

In  many  of  the  Pacific  seaports  the  plague  has  a  footing,  and 
during  my  visit  to  some  of  them  deaths  occurred  from  it;  the 
same  may  be  said  of  the  Atlantic  ports.  It  is  thus  to  be  seen  that 
not  only  was  the  Zone  area  to  be  purified  and  purged  of  disease 
causes,  but  it  was  to  be  protected  from  the  invasion  of  disease 


12  MEAES:   THE   TRIUilPH   OF  AMERICAN  MEDICINE 

through  the  gates  of  commerce  at  each  end.  These  conditions, 
within  and  mthout,  confronted  Col.  Gorgas  in  the  organization 
of  his  sanitary  system,  and  enhanced  greatly  the  difficulties  to 
be  overcome  in  perfecting  it.  Two  chief  propositions  present 
themselves  in  the  study  of  the  sanitary  system  which  was  planned 
and  adopted.  The  first  one  may  be  regarded  as  of  major  impor- 
tance— that  of  the  prevention  of  disease  by  the  removal  of  causes — 
and  the  second,  the  guardianship  of  the  well  and  the  care  of  the 
sick  from  all  causes  and  of  those  sustaining  injuries  in  the  work 
of  canal  construction. 

The  general  state  of  health  in  the  community  of  ofi&cials  and 
work  people  is  maintained  by  rigid  inspection  of  all  food  issued 
for  consumption,  and  by  weekly  examinations  and  analyses  of  the 
water  supply  from  all  sources,  municipal  water  suppKes,  streams, 
and  springs,  and  condensed  water.  The  houses  in  which  officials 
and  work  people  Hve  claim  special  attention,  and  equally  well 
those  of  the  inhabitants  of  Colon  and  Panama  City.  While  the 
political  government  of  these  cities,  which  are  within  the  limits 
of  the  Canal  Zone,  rests  with  the  governmental  authorities  of 
the  RepubKc,  the  sanitary  and  police  control  are  super\dsed  by 
the  officers  of  the  Canal  Commission  under  the  authority  of  the 
United  States  Government.  This  is  absolutely  necessary  for  the 
maintenance  of  pubUc  order  and  of  correct  sanitary  conditions 
within  the  Zone.  The  plans  for  the  construction  of  new  houses 
must  be  submitted  for  approval  to  the  health  officers  of  these 
cities,  and  the  buildings  within  the  Zone  for  the  employees  are 
constructed  under  the  same  exacting  conditions.  Owing  to  the 
presence  of  the  Plague  on  both  coasts  of  Central  and  South 
America,  it  is  especially  necessary  that  new  houses  should  be  con- 
structed so  as  to  make  them  rat-proof  and  prevent  the  harboring 
of  rats.  These  conditions  are  accomplished  by  either  raising  them 
three  feet  from  the  ground  on  supports  of  concrete  or  other 


Oiled  concrete  drainage  ditch  near  Ancon. 


Typical  malarial  mosquito  (Anopheles)  breeding  pool  near  dump 


MEARS:   THE   TRIUMPH   OF  AMERICAN  MEDICINE  1 3 

material,  covered  with  tin,  so  that  the  rats  cannot  secure  a  footing 
on  them,  or  if  placed  on  the  ground  they  must  rest  on  a  floor  of 
concrete.  All  buildings  are  submitted  to  inspection  at  regular 
intervals;  those  not  in  a  sanitary  condition  in  the  cities  must  be 
placed  in  that  condition,  if  possible,  by  the  owner,  or  they  are 
condemned  and  destroyed.  Disinfection  and  fumigation  are 
practised  in  all  buildings  in  which  cases  of  infectious  diseases  have 
occurred.  Permits  to  repair  buildings  and  to  occupy  them  tem- 
porarily or  permanently  must  be  obtained  from  the  health  officials. 

In  the  cities  of  Panama  and  Colon  systems  of  sewerage  have 
been  installed,  and  all  buildings  must  make  connections  with  the 
sewers.  This  condition  exists  in  all  of  the  communities  in  which 
residential  or  hospital  buildings  are  located.  Outside  of  the  sewered 
areas  in  the  native  villages  pit  closets  are  used,  and  are  disinfected 
weekly  with  a  solution  of  larvacide,  a  very  effective  and  cheap 
preparation,  consisting  of  crude  carbolic  acid,  resin,  and  caustic 
soda. 

Uncompromising  warfare  is  carried  on  against  the  mosquito, 
anopheles  and  stegomyia.  In  the  cities  and  in  the  regions  of  the 
Zone  occupied  by  officers  or  laborers  all  breeding  places  are  either 
destroyed  or  kept  in  a  sanitary  condition,  free  from  larvae,  by 
oiling  or  the  use  of  larvacide.  Stagnant  pools  and  collections  of 
water  are  filled  up  or  in  large  areas  drained  by  ditches  which  are 
maintained  in  sanitary  condition.  ''Special  attention  is  given  to 
defective  roof  gutters,  which  become  prolific  breeding  places  in 
the  water  which  remains  in  them  owing  to  the  want  of  proper 
inclination  to  carry  off  all  water  which  comes  into  them  in  a 
rainfall.  When  very  defective  by  reason  of  sagging,  they  are 
removed,  and  the  owners  of  buildings  are  required  to  replace 
those  thus  disposed  of  by  new  gutters.  In  some  instances  simple 
punching  of  the  sagging  portion  keeps  the  gutter  empty. 

At  first,  considerable  opposition  was  met  with,  and  the  Governor 


14  HEARS :  THE  TRIUMPH  OF  AMERICAN  MEDICINE 

of  the  District  was  requested  to  amend  the  decree  giving  authority 
to  the  health  officials,  so  that  this  important  work  could  not  be 
interfered  with.  All  receptacles  containing  water  for  use  are 
required  to  be  screened.  The  constant  inspection  of  known 
breeding  places  is  maintained,  and  the  mosquito  brigade  is  on 
continuous  and  vigilant  duty.  Persistent  search  is  made  for  sus- 
pected places,  and  the  surveillance  is  never  relaxed.  Although  no 
case  of  yellow  fever  has  occurred  on  the  Canal  Zone  since  the  year 
1905,  the  search  for  the  stegomyia  and  its  destruction  continues. 

The  fact  that  both  the  adult  and  larvae  of  stegomyia  species 
are  transported  by  railroad  trains  exposes  the  Zone  to  dangers 
which  require  that  the  most  exacting  precautions  should  be 
taken;  their  escape  from  patients  before  entering  quarantine  is 
quite  within  the  range  of  possibility  and  greatly  increases  the 
work  of  prevention.  Fortunately  their  recognition  is  within 
scientific  knowledge,  and  their  detection  is  thus  faciKtated.  All 
patients  are  transported  to  the  hospitals  on  screened  stretchers  or 
in  screened  ambulances. 

Notwithstanding  the  rigid  system  of  prevention,  through 
sanitary  measures  which  have  been  established  on  the  Zone,  the 
community  is  still  further  protected  from  the  invasion  of  the 
mosquito,  the  breeding  places  of  which  may  happen  to  escape 
destruction,  by  a  most  perfect  plan  of  house  screening.  Resi- 
dences particularly  are  screened,  the  rustless  wire  (copper)  being 
employed  for  this  purpose.  Not  only  are  the  doors  and  windows 
protected,  but  the  porches,  including  first  and  second  story,  are 
securely  enclosed.  On  first  view,  the  appearance  is  novel,  and 
quite  suggestive  of  huge  bird  cages.  The  assured  safety  thus 
given  dissipates  any  feeling  that  the  inmates  are  unwilKng  occu- 
pants of  the  apparent  houses  of  detention. 

The  known  part  taken  by  the  fly,  the  common  house  fly,  in 
transporting  germs  of  diseases  makes  it  a  source  of  grave  danger, 


HEARS :   THE   TRIUMPH   OF  AMERICAN  MEDICINE  1 5 

and  provokes  measures  of  protection  against  its  existence.  These 
measures  consist  in  supplying  all  buildings  of  the  Commission 
with  range  closets,  water,  and  sewer  connections.  The  pit  closets 
in  the  native  villages  are,  so  far  as  possible,  made  fly-proof,  and 
are  disinfected  weekly  by  a  solution  of  larvacide  to  prevent  fly- 
breeding.  By  this  means  of  prevention  the  fly  becomes  a  "rara 
avis"  within  the  Zone  limits,  and  is  very  much  less  in  number 
than  in  the  villages  and  towns  of  our  country.  During  my  stay  I 
saw  but  one  specimen,  and  the  comfort  and  freedom  from  danger 
enjoyed  in  the  homes  by  their  absence  is  very  great,  and  quite 
in  contrast  to  the  conditions  caused  by  them  in  our  homes,  be  it 
in  the  coimtry  or  in  the  city. 

The  rat  as  the  habitat  in  its  hairy  integument  of  the  plague 
flea  demands  extermination.  The  annual  report  of  the  Department 
of  Sanitation,  of  the  Isthmian  Canal  Commission  for  1909,  gives 
the  number  of  rats  caught  and  killed  in  Panama  City  during  the 
year  as  17,004;  in  the  city  of  Colon  the  number  killed  was  7284. 
In  Panama  City  672  dogs  were  poisoned,  and  in  Colon  66.  The 
report  of  the  Board  of  Health  Laboratory,  included  in  the  report 
of  the  Department  of  Sanitation,  contains  record  of  24  examina- 
tions of  rabies  and  suspects,  and  11  cases  of  preventive  treat- 
ment for  hydrophobia  were  completed. 

An  interesting  item  relates  to  the  existence  of  crab-holes  along 
the  shores.  In  Colon  7600  were  oiled  and  224,220  were  worked. 
In  Cristobel  43,200  were  worked,  and  in  Mount  Hope  73,229. 
Grass  and  weeds  afford  a  harbor  for  mosquitoes.  In  Panama 
City  1,961,395  square  feet  of  weeds  and  grass  were  cut  and 
removed.  In  Bocas  del  Toro  340  square  yards  were  cut  and 
burned.  In  Colon  460  acres  of  vegetation  were  removed.  In 
Colon  1,319,514  water  receptacles  were  treated,  and  in  Bocas  del 
Toro  554  were  overturned — 158  breeding  places  of  the  mosquito 
were  found  in  barrels,  tubs,  etc.,  and  destroyed. 


1 6  hears:  the  triumph  of  American  medicine 

The  antimalarial  crusade  is  carried  into  the  houses  and  into 
the  public  eating  places  of  the  employees  of  the  Canal  Commission. 
On  the  tables  are  placed  bottles  of  the  tonic  quinine  solution  which 
is  taken  with  the  meals.  Blood  examinations  are  made  to  deter- 
mine the  presence  of  the  malarial  parasite.  The  complete  report 
of  Col.  Gorgas  for  the  year  1909  states  the  issues  of  quinine  for 
the  year  to  have  been  3,148,053  pounds  avoirdupois,  an  average 
per  month  of  262,337  pounds,  representing  an  issue  of  66.74 
pounds  during  the  year  for  each  of  the  47,167  employees  reported 
as  being  present  and  engaged  in  the  Canal  construction. 

I  have  selected  these  few  items  from  Col.  Gorgas'  report  to 
illustrate,  in  brief,  the  character  and  magnitude  of  the  work 
carried  on  to  prevent  sickness  among  the  employees  of  the  Isthmian 
Canal  Commission,  and  to  maintain  a  state  of  health  conducive  to 
the  most  successful  results  in  conducting  the  constructive  work 
on  the  Canal.  As  a  test  of  the  success  of  the  sanitary  work,  it  is 
interesting  to  consider,  among  other  diseases,  the  hospital  admis- 
sions and  deaths  from  malaria  in  the  years  1905  to  1909. 

Hospital  admissions  per  thousand  of  employees:  1905,  514; 
1906,  821;  1908,  282;  1909,  215.  In  1906,  owing  to  exceptional 
rains,  mosquitoes  were  bred  in  many  places  and  in  large  numbers, 
and  it  seemed  not  quite  possible  to  control  their  existence  by 
the  measures  which,  under  ordinary  conditions,  proved  to  be  so 
successful.  In  the  same  period  of  time  the  deaths  from  malaria 
were:  1905,  86;  1906,  233;  1908,  73;  1909,  52.  The  vital  statistics 
for  1909,  as  given  by  Col.  Gorgas  in  his  report,  show  a  marked 
improvement.  In  1905  and  1906,  with  the  number  of  employees 
16,512  and  26,547  respectively,  the  death  rate  was  25.86  and  41.73. 
In  1908  and  1909,  with  the  number  of  employees  43,891  and  47,167 
respectively,  the  death  rate  was  13.01  and  10.64.  Iii  the  year 
1909  the  annual  death  rate  per  thousand  of  11,662  white  employees 
was  6.43  from  disease  and  3.43  from  violence;  total,  9.86.     Of 


/ 


r 


Water  barrel  made  mosquito  proof. 


L 


HEARS :  THE  TRIUMPH  OF  AMERICAN  MEDICINE  1 7 

Americans,  average  number  8386,  including  employees  and  their 
families,  the  death  rate  per  thousand  was  from  disease,  4.05; 
from  violence,  2.27;  total,  6,32.  A  further  statement  of  the 
death  rate  of  the  total  population,  including  the  cities  of  Colon 
and  Panama,  and  the  country  between  them,  shows  it  to  have  been 
in  1905,  49.94,  and  in  1909,  18.19. 

Assuredly  nothing  can  be  added  to  these  clear  and  authentic 
statements  to  demonstrate  the  value  of  the  system  of  sanitary 
work  inaugurated  by  Col.  Gorgas  and  so  faithfully  and  success- 
fully conducted  by  him  and  his  corps  of  able  assistants. 

From  the  consideration  of  the  measures  taken  to  prevent 
disease  it  will  be  interesting  to  observe  how  the  sick  are  cared  for. 
For  the  entire  sanitary  work  on  the  Zone  and  in  the  cities  of 
Panama  and  Colon  there  is  a  personnel  of  1244,  the  average 
number  of  employees  at  work  during  the  year,  distributed  in  the 
chief  sanitary  office,  care  of  property,  quarantine  service,  health 
officers,  in  hospitals,  sanitarium,  asylum  for  lepers,  and  dispen- 
saries. There  are  four  hospitals,  including  a  leper  asyliun,  and 
one  sanitarium  and  nineteen  dispensaries.  There  is  a  hospital 
for  the  insane,  which  is  conducted  for  the  RepubKc  of  Panama, 
which  pays  to  the  Commission  for  each  patient,  seventy-five  cents 
per  day.  The  Canal  Zone  Government  pays  thirty  cents  a  day 
in  the  hospitals  for  patients,  and  outside  patients,  as  members  of 
the  families  of  employees  and  others,  pay  the  same.  Altogether 
the  paying  patients  from  all  sources  in  the  Zone  contribute  in  the 
year  $98,081.72. 

Ancon  is  the  Zone  tov/n  at  the  Panama  end  of  the  Canal  and 
opposite  to  Panama  City.  Here  is  the  office  of  the  Chief  Sanitary 
Officer  and  the  Ancon  Hospital,  which  is  the  largest.  This  was 
the  site  of  the  French  Hospitals.  Of  the  seventy-five  buildings 
for  hospital  purposes,  about  fifty  were  built  by  the  French,  which 
were  found  by  the  Americans  covered  by  the  jungle.    Twenty-five 


1 8  HEARS :  THE  TRIUMPH   OE  AMERICAN  MEDICINE 

of  the  buildings  are  occupied  by  the  Staff.  In  the  Ancon  Hos- 
pital there  are  900  beds  for  medical  purposes,  in  27  wards;  320 
beds  for  surgical  patients,  in  10  wards;  5  wards  for  contagious 
and  infectious  diseases;  2  wards  and  six  rooms  for  tuberculosis. 

A  maternity  department  is  conducted  for  the  famihes  of  white 
American  employees,  who  pay  in  private  rooms  $2.50  a  day  and 
$1.00  in  the  general  wards.  Thirty  contract  physicians  are 
employed  by  the  Isthmian  Commission,  who  report  to  Colonel 
Gorgas,  Chief  Medical  Officer.  One  hundred  and  two  trained 
nurses,  93  female,  9  male,  trained  in  the  United  States,  are  on 
duty,  with  138  attendants  acting  as  orderlies.  The  Colon,  Culebra, 
and  Santo  Tomas  Hospitals,  with  the  Leper  Asylimi  at  Palo  Seco 
and  the  Tobago  Sanitarium,  have  much  less  capacity,  and  require 
the  services  of  a  much  smaller  corps  of  officers  and  attendants. 
Attached  to  the  daily  trains  on  the  Panama  Railroad  from  Colon 
to  Panama  are  hospital  cars,  arranged  with  berths  which  can  be 
raised  and  lowered  conveniently,  forming  comfortable  stretchers 
and  beds  for  the  sick  and  injured  who  may  be  taken  aboard  at 
the  different  stations,  and  in  this  manner  transported  with  a 
minimum  degree  of  discomfort  to  the  Ancon  Hospital.  In  charge 
of  these  cars  is  a  medical  officer,  with  attendants,  who  gives 
attention  to  patients  en  route,  and  such  medical  services  as  may  be 
needed.  Four  chaplains  are  assigned  to  duty  in  the  hospitals,  and 
two  chapels,  one  Protestant  and  one  Roman  Catholic,  supply 
places  of  worship.  Seven  buildings,  at  different  points  in  the  Zone, 
provided  by  the  Isthmian  Commission,  are  devoted  to  the  work 
of  the  Young  Men's  Christian  Association,  containing  reading, 
library,  and  amusement  rooms. 

The  milk  supply  comes  from  the  dairy,  in  which  there  are  93 
cows,  which  were  brought  from  the  United  States  and  were  care- 
fully tested  for  tuberculosis  before  being  sent  and  after  arrival  on 
the  Zone.    Great  care  is  given  to  the  feeding,  stabling,  and  milking 


MEARS:  THE  TRIUMPH  OF  AMERICAN  MEDICINE  1 9 

of  the  COWS,  and  prompt  measures  taken  in  the  treatment  of  any 
diseases  which  may  occur.  The  milk  is  pasteurized.  The  poultry 
farm  contains  some  six  hundred  chickens  which  are  carefully 
watched  for  diseases.  An  autopsy  is  made  of  all  dying  from 
disease  and  the  cause  of  death  determined  and  recorded. 

One  of  the  most  important  sections  of  the  Isthmian  Canal 
Commission  is  the  Laboratory'-  of  the  Board  of  Health,  forming 
a  part  of  the  department  of  sanitation,  in  charge  of  Samuel  T. 
Darling,  M.D.,  Chief  of  the  Laborator}^  Through  the  courtesy 
of  Dr.  Darling  I  was  permitted  to  observe  the  methods  of  work 
carried  on  in  the  laboratory,  which  made  m}^  \isit  full  of  interest. 
The  equipment  of  the  laboratory  is  complete,  the  Government, 
through  the  Canal  Commission,  providing  all  that  is  necessary 
to  conduct  the  important  work  of  this  department.  The  routine 
work  in  the  laborator}^  includes  examinations,  pathological  and 
bacteriological,  for  the  hospitals,  autopsies,  surgical  patholog)'- 
studies,  Wassermann  reactions,  blood  cultures,  vaccines,  chemical 
analyses  for  the  Commission  and  chemical  examinations  for  the 
Ancon  and  other  hospitals,  of  milk  and  foods  (toxicological), 
special  examinations  of  urine,  etc.,  chemical,  bacteriological,  and 
microscopic  examination  of  all  Zone  water  supplies,  including  five 
reservoirs.  The  research  work  involves  various  subjects,  reports 
upon  which  have  been  published  by  Dr.  Darling.  Possibly  the 
most  important  is  that  entitled  "Studies  in  Relation  to  ]Malaria," 
pubhshed  by  the  Government  Printing  Ofib.ce,  Washington,  19 10. 
Most  elaborate  experiments  were  conducted  in  determining  some 
of  the  factors  concerned  in  the  prevention  and  transmission  of 
malarial  fever  in  the  Canal  Zone.  Among  the  most  interesting 
results  obtained  was  the  determination  of  the  influence  exerted  b}' 
quinine  upon  the  malarial  parasite. 

The  recognition  of  the  mosquitoes  common  to  the  Zone,  their 
breeding  habits,  and  the  determination  made  of  the  species  of 


20  HEARS :   THE   TRIUMPH  OF  AMERICAN  MEDICINE 

anopheles  hospitable  to  malaria  and  those  transmitting  it  claimed 
critical  attention  and  study.  Eleven  species  of  anopheles  were 
collected  in  the  Canal  Zone  in  the  five  years  given  to  the  study. 
It  is  interesting  to  note  that  observation  determined  the  fact  that 
the  characteristic  musical  note  of  the  mosquito  is  caused  by  the 
vibration  of  the  proboscis  and  not  by  the  wings,  as  commonly 
believed.  The  proboscis  is  therefore  not  only  a  weapon  of  offence, 
but  an  organ  of  harmony — an  inharmonious  combination. 

In  concluding  this  necessarily  brief  and  incomplete  recital 
of  what  sanitary  science  in  this  day  has  accomplished  in  the  con- 
servation of  the  health  of  the  working  community  in  the  Canal 
Zone,  many  questions  of  far-reaching  importance  suggest  them- 
selves for  consideration  and  for  study.  To  one,  as  is  the  writer, 
familiar  by  actual  contact  in  field  and  hospital  with  the  appalling 
conditions  which,  through  the  absence  of  scientific  knowledge, 
confronted  the  Medical  Officer  of  the  Army  in  the  days  of  the 
Civil  War,  great  must  be  his  satisfaction  in  noting  the  changes 
which  the  last  half  century  has  wrought  in  the  development  and 
progress  of  scientific  medicine. 

In  truth  and  in  justice  it  can  be  said  that  in  no  department 
of  medical  effort  has  progress  been  more  pronounced  than  in  the 
medical  corps  of  our  public  service,  army,  navy,  and  marine 
hospital  service.  The  writer  feels  in  this  respect  that  he  may  be 
permitted  to  speak  with  a  shadow  of  authority  as  it  came  to  him 
in  his  earlier  teaching  days  to  place  in  the  medical  department  of 
the  public  service  about  ninety  of  his  private  students.  He  knew 
of  the  conditions  existing  in  those  days  and  of  the  requirements 
exacted  by  the  Boards  of  Examination  guarding  the  gates  of  admis- 
sion into  the  service,  and  with  inspiring  appreciation  and  gratifying 
pride  he  has  watched  the  gradual  but  sure  advancement  in  scien- 
tific knowledge  and  in  adaptive  methods  which  have  taken  place. 

The  war  colleges  of  our  army,  the  hospital  ships  of  our  nav)^. 


HEARS :  THE  TRIUMPH  OF  AMERICAN  MEDICINE  21 

the  research  laboratories  of  our  marine  hospital  service,  all  speak 
in  resounding  tones  of  progress  in  scientific  medicine,  and  place 
our  public  medical  service  in  the  very  forefront  of  achievement 
among  the  nations  of  the  world.  No  longer  does  the  medical 
department  of  the  different  branches  of  the  military  and  public 
service  occupy  the  subordinate  position  assigned  to  them  in  the 
days  of  the  Napoleonic  campaigns,  or  even  in  those  of  more  recent 
times. 

In  the  earlier  days  the  commanding  general  of  the  army 
concerned  himself  much,  through  his  under-ofhcers,  about  the 
state  of  efficiency  of  his  commissary  and  quartermasters'  depart- 
ments, in  order  that  he  might  without  interruption  continue  his 
line  of  march  to  meet  the  enemy  and  engage  him  in  battle.  The 
medical  department  was,  in  a  certain  sense,  an  after- thought;  the 
sick  and  wounded  could  be  left  behind  in  field  hospital  or  in 
barracks,  but  the  impedimenta,  the  quartermaster  and  commissary 
stores  must  be  in  as  efficient  state  as  possible.  He  did  not  know 
and  his  medical  officers  could  not  tell  him  at  that  time  how  impor- 
tant, absolutely  necessary,  it  was  that  the  medical  officer  should 
march  side  by  side,  as  it  were,  with  the  soldier. 

Under  his  care  the  soldier  endures  the  fatigue  of  the  march  or 
comes  to  the  battle  Hne  as  an  efficient  agent  in  the  conflict;  between 
him  and  disease  and  pestilence  the  medical  officer  stands,  without 
fear  and  with  undaunted  courage,  erecting  barriers  of  defence 
and  batthng,  it  may  be  with  greater  skiU  than  the  officer  of  the 
line,  against  the  onslaught  of  the  oft-times  concealed  enemy. 
In  his  hands  the  soldier  becomes  a  unit  of  protection  against  all 
of  the  inffiiences  of  his  environment  and  the  methods  of  his  life — 
he  is  not  only  taught  to  protect  himseh,  but  to  protect  all  about 
him.  In  a  sense  every  act  of  his  life,  as  every  function  of  his 
physical  being,  becomes  the  intelligent  care  of  the  medical  officer. 
Such,  in  truth,  are  the  conditions  in  existence  today  under  the 


22  MEARS:   THE   TRIUMPH   OF  AMERICAN  MEDICINE 

progressive  methods  which  the  advanced  state  of  medical  science 
confers. 

It  may  be  urged  that  it  requires  military  discipline  to  achieve 
such  results  as  we  observe  in  the  Canal  Zone.  Recognizing.  aS 
we  all  must,  the  influence  exerted  by  a  state  of  military  ccatrol 
in  conquering  unsanitary  conditions,  and  in  obtaining  unresisting 
compUance  with  those  which  are  conducive,  in  all  respects,  to  the 
conservation  of  health  which  may  be  permanently  maintained, 
we  find  some  examples  of  places  presenting  conditions  similar 
to  those  which  had  existed  in  the  Canal  Zone,  and  which  have 
been  completely  removed  by  civic  efforts. 

In  a  visit  made  in  the  last  winter  to  South  America,  I  landed 
in  Santos,  Brazil,  a  city  of  41,000  population,  and  one  of  the  best 
ports  on  the  Atlantic  Ocean.  A  few  years  ago  this  port  was 
devastated  by  raging  epidemics  of  yellow  fever.  To  such  extent 
did  the  disease  prevail  that  vessels  coming  into  the  port  lost  in 
several  instances,  and  very  quickly,  their  entire  crews  from  the 
disease,  ofl&cers  and  men,  before  they  could  be  unloaded.  I  was 
told  of  one  instance  in  which  a  vessel  lay  anchored  in  the  harbor 
for  a  period  of  eighteen  months,  unloaded,  with  cargo  perishing 
in  the  hold. 

Inspired  by  the  fact  that  this  city  was  the  greatest  shipping 
port  of  coffee  in  the  world,  the  government  and  municipal  author- 
ities inaugurated  a  system  of  modern  hygienic  improvements  which 
destroyed  the  breeding  places  of  the  stegomyia  mosquito,  and 
banished  yellow  fever,  converting  its  beautiful  harbor  from  a 
home  of  pestilence  into  an  attractive  seaside  home,  with  the  ships 
of  many  nations  unloading  and  loading  in  guaranteed  security 
alongside  of  its  commodious  and  well  arranged  quays. 

Such  results  had  been  obtained  by  civic  effort,  and  they  may 
be  accomplished  in  other  places  where  knowledge  of  sanitary 
science,  combined  with  intelligent  cooperation — ^freed  from  the 


MEARS:  THE   TRIUMPH  OF  AMERICAN  MEDICINE  23 

demoralizing  and  destroying  grasp  of  the  political  boss,  surcharged 
with  graft — ^is  employed  in  correcting  imsanitary  conditions, 
conducing,  in  this  manner,  to  the  prevention  and  to  the  staying 
of  the  ravages  of  disease. 

The  world  should  not,  as  we  hope  and  believe  it  will  not,  look 
again  upon  a  picture  such  as  the  Chickamauga  Camp  in  the 
Spanish-American  War,  which  portrayed  in  such  lurid  colors  the 
hiuniliation  of  American  medicine  and  as  well  the  inefficiency 
of  military  control.  While  it  is  true  we  were  on  the  eve  of 
discoveries  of  great  import,  born  of  the  experience  which  we 
gained  in  the  occurrence  and  in  the  progress  of  the  war,  it  may 
be  said,  without  fear  of  successful  contradiction,  that  the  con- 
ditions which  provoked  such  holocausts  were  in  large  measure 
preventable.  It  is  true  that  we  did  not  know  of  vaccination  as 
a  prophylactic  measure  against  typhoid  fever— a  recent  gift  of 
laboratory  research  and  of  experimental  medicine,  which  will 
take  its  place  with  vaccination  against  smallpox,  as  a  monumental 
contribution  to  the  promotion  of  the  well-being  and  welfare  of 
the  human  race — we  did  know,  however,  of  the  great  necessity 
of  microscopic,  chemical,  and  bacteriological  examinations  of 
food  and  drink  supplies.  The  bacillus  of  typhoid  fever  had  been 
isolated  in  the  year  1880,  and  we  knew  the  importance  of  its  destruc- 
tion in  the  excreta.  We  knew  of  the  necessity  of  maintaining  all 
sinks  and  pits  in  rigid  sanitary  conditions,  destroying  by  the  free 
application  of  the  most  powerful  disinfectants  all  microorganisms. 
Our  knowledge,  at  the  time,  of  the  part  taken  by  the  common  house 
fly  in  conveying  disease  germs  was  sufficient  to  provoke  measures 
of  protection  against  it,  and  the  employment  of  agents  to  prevent 
fly  breeding  in  all  places  favorable  to  such  conditions.  We  had 
sat  for  two  decades  or  more  xmder  the  instruction  of  the  great 
teacher  who  had  taught  us  the  far-reaching  principles  of  antisepsis, 
and  had  demonstrated  its  practical  application  in  all  conditions 


24  HEARS :   THE   TRIUMPH   OF  AMERICAN  MEDICINE 

involving  the  sick  and  wounded — the  subjects  of  the  wounds  of 
accident  and  of  the  wounds  of  intention.  We  knew  the  value  of 
incineration  in  the  disposal  of  all  refuse  matter.  The  gospel  of 
Cleanliness,  evolving  asepsis,  as  the  physician  and  the  surgeon 
understand  it,  or  should  understand  it,  had  been  preached  abroad 
in  the  land,  enjoining  all  to  be  clean,  through  its  unremitting 
application  in  practice. 

All  of  these  things  and  many  more  we  did  know,  and  yet  the 
dread  disease  typhoid  fever,  stalked  through  the  camp,  apparently 
unrestrained,  laying  low  one-sixth  of  the  entire  command — 
20,000  cases  out  of  an  army  corps  of  120,000  troops— with  a  case 
mortality  of  7  per  cent.  The  annals  of  civilized  warfare  do  not 
present  a  page  quite  so  black,  recording  conditions  which  the 
knowledge  of  the  day  should  not  have  permitted  to  exist. 

The  progress  of  scientific  medicine  is  onward,  and  today  in  the 
camps  of  our  armies,  on  the  battleships  of  our  navy,  and  at  the 
quarantine  stations  of  our  marine  hospital  service  it  shines  with 
added  luster,  the  medical  officer  taking  his  place,  as  of  right  it 
belongs  to  him,  in  the  front  rank  with  those  whose  efforts  con- 
tribute to  civil  and  miHtary  efficiency.  Moved  with  pride  by  the 
achievements  of  his  noble  profession  and  inspired  by  loyal  devo- 
tion to  the  corps  of  which  he  is  a  member,  he  bears  aloft  the  banner 
of  progress  and  scientffic  research,  imfurled  by  that  distinguished 
disciple  of  medicine  and  honored  medical  officer  of  the  United 
States  Army,  William  Beaumont,  who  nearly  a  century  ago  gave 
to  the  world  and  to  scientific  medicine,  obtained  through  accurate 
research  work  in  the  living  subject,  the  first  knowledge  it  had 
of  the  functions  of  the  stomach  and  of  the  constituent  elements 
of  the  gastric  juice  and  their  action  on  foods.  His  name  will  live 
as  the  pioneer  in  scientific  research  in  the  history  of  American 
medicine. 

Truly,   may  we   not  congratulate  our  professional  brethren 


MEARS:   THE   TRIUMPH  OF  AMERICAN  MEDICINE  25 

who  have  so  unselfishly  devoted  their  talents  and  their  lives  to  the 
service  of  their  country  upon  the  great  work  they  have  accom- 
plished, which  stirs  our  national  pride,  and  proclaims  to  the 
world  their  monumental  achievements,  as  the  President  and  their 
Commander-in-Chief  has  so  well  proclaimed  them,  ''Marvels  of 
American  courage,  energy,  and  scientific  thoroughness,  skill, 
research,  and  original  discovery."  So  long  as  preventable 
destroying  diseases  flee  before  the  conquering  hosts  of  efi&cient 
sanitation,  so  long  will  the  labors  of  these  noble  benefactors  of  the 
human  race  be  cherished.  Upon  their  brows  we  place  wreaths  of 
victory,  laurels  won  not  in  the  fierce  conflict  of  clashing  arms,  but 
in  the  home  and  in  the  daily  walk  in  life,  over  which  the  Angel  of 
Peace  spreads  her  golden  wings.  As  we  acclaim  them  victors 
in  peace,  no  less  than  in  war,  we  enshrine  them  in  the  grateful 
hearts  of  their  countrjrmen. 


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